The impact of red blood cell transfusions on perioperative outcomes in the contemporary era of liver resection

Background. Perioperative red blood cell transfusions (RBCTs) are common in patients undergoing partial hepatectomy. We sought to explore the relationship between RBCTs and posthepatectomy perioperative outcomes in the contemporary surgical era. Methods. We reviewed all patients undergoing partial hepatectomy from 2003 to 2012. Primary outcome was 30-day major morbidity (MM). We compared patients who did and received perioperative RBCT (defined as from time of operation until 30 days postoperatively. Multivariate analysis was performed to identify factors associated with MM and duration of stay, using logistic and negative binomial regression. Results. Among 712 patients, 16.8% experienced MM, of whom 53.3 % received RBCT. Patients who received RBCT experienced MM more commonly (30.8% vs 11. 1%; P < .001). On multivariate analysis, the only factors associated with MM were age (relative risk [RR], 1.03; 95 % CI, 1.00-1.06), greater operative time (RR, 1.29; 95 % CI, 1.11-1.50), and RBCT (RR, 3.57; 95 % CI, 1.81-7.04). RBCT was associated independently with a greater duration of stay (RR, 1.47; 95 % CI, 1.13-1.91). Conclusion. Receipt of RBCT is associated independently with perioperative MM and prolonged hospitalization after partial hepatectomy. These findings further the rationale supporting the need for a strategy of blood management to decrease the use of RBCT after hepatectomy.